VBS Waiver Form
Please fill out this form to complete the VBS waiver.
Participant Name
First Name
Last Name
Parent/Guardian Name
First Name
Last Name
Participant Age
Parent/Guardian Email
example@example.com
Parent/Guardian Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Please list any allergies or medical conditions
I consent to my child's participation in the VBS program.
Yes
No
I authorize the VBS staff to seek emergency medical treatment for my child if necessary.
Yes
No
By signing this form, I agree to release and hold harmless the VBS program, staff, and volunteers from any claims or liability arising from my child's participation.
Submit
Should be Empty: